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Icarus Project Harm Reduction Guide To Coming Off Psychiatric Drugs (Will Hall)

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To the eternal shame of the medical establishment, it has not produced any guidelines for tapering off psychiatric drugs.

It's been left to patients themselves to figure it out.

In April 2008 the Icarus Project http://theicarusproject.net/ and the Freedom Center http://www.freedom-center.org/welcome, two patient organizations, published the Harm Reduction Guide To Coming Off Psychiatric Drugs & Withdrawal.

 

(Please see links at the bottom of this post to free PDF download of HARM REDUCTION GUIDE TO COMING OFF PSYCHIATRIC DRUGS AND WITHDRAWAL available in various languages)

About the initial edition, according to the Icarus Project:


"The Icarus Project and Freedom Center's 40-page guide gathers the best information we've come across and the most valuable lessons we've learned about reducing and coming off psychiatric medication. Includes info on mood stabilizers, anti-psychotics, anti-depressants, anti-anxiety drugs, risks, benefits, wellness tools, psychiatric drug withdrawal, information for people staying on their medications, detailed Resource section, and much more. A 'harm reduction' approach means not being pro- or anti-medication, but supporting people to make their own decisions balancing the risks and benefits involved...."

Selections about tapering, starting on page 35 of the 2012 second edition of the Guide:

 

Quote

Coming Off: Step by Step
Reducing Drug Dosage Safely

The following are general considerations, and no single pattern fits everyone:

  • Usually it is best to go slow and taper gradually. Though some people are able to successfully go off quickly or all at once, withdrawing from psychiatric drugs abruptly can trigger dangerous withdrawal effects, including seizures and psychosis. As a general principle, the longer you were on the drug, the longer you may need to take going off of it. Some people take years to come off successfully.

    ....
  • Make a plan. Some people may go slower or faster, but a good guideline is 10% or less reduction of your original dose every 2-3 weeks or longer. Do this until you reach half the original dosage, then go down by 10% of the new level. Make a chart showing how much of each drug you will be taking. Get pills of different size, a pill cutter (some pills shouldn’t be cut though), or measuring cup. For example, if you started with 400 mg. daily, you could first reduce the dose by 10 percent (40 mg.), to 360 mg. After 2 weeks or more if the feelings are tolerable, the next 40 mg. reduction would take you down to 320 mg., then 280 mg., 240 mg., and so on. If you got to 200 mg. and found that a further drop of 40 mg. was too difficult, you could reduce by 10 percent of 200 mg. (20 mg.), and then go down to 180 mg. etc. This is just a general guideline, however, and many people do things differently. Ask a pharmacist.
  • If you have been on a medication a very long time, you may want to start with an even smaller reduction and then stay there for a while. Be flexible - coming off completely might not be right for you.
  • While gradual is usually best, some side effects are so serious, such as neuroleptic malignant syndrome or lamictal rash, that abrupt withdrawal is considered medically necessary. Keep up with lab tests and communicate about what’s happening.
  • After your first reduction, monitor any effects carefully. Stay in close contact with your prescriber, a friend, support group, or counselor. Consider keeping a journal of your symptoms, maybe with someone’s help. Remind yourself that if symptoms got worse directly after you reduced the drug, they may be withdrawal effects and may pass.
  • Especially with anti-depressants and benzodiazepines, you can sometimes ease withdrawal by switching to an equivalent dose of a similar drug with a longer “half-life” – more gradual time leaving your system. Allow yourself time, at least 2 weeks or more, to adjust to your new drug, or longer if there is difficulty switching.

    ....
  • When taken regularly, benzodiazepines are highly addictive and sometimes the most difficult to come off of, especially towards the end. You may want to leave these to last.
  • It is very common for people to start the reduction process and then realize they are going a bit too fast. If withdrawal is unbearable, too difficult, or continues for too long, increase the dose again. Give yourself two weeks or more and try again. If you still have difficulty, raise the dose and then reduce more slowly, or just stay at the dosage where you are.
  • If you do end up in crisis, see it as one step in a larger process of learning and discovery, not a failure. If you can, resume the minimum medication needed to regain your stability, rather than starting all over again. Keep in mind that your obstacle might be the drug withdrawal itself, not underlying emotions or extreme states, or a combination of both.
  • Remember, you may find it difficult to go off completely, so accept this as a possibility and be flexible with your goals. Include other ways to improve your life and well-being, and wait to try again when the time is right.

 

 

On SurvivingAntidepressants.org, we have seen many people need to taper more slowly, sometimes with much smaller reductions than 10%, and at intervals of 3 or 4 weeks.

 


 

Admin note: Download the latest version of the guide in English and other languages here:

 

http://theicarusproject.net/resources/publications/harm-reduction-guide-to-coming-off-psychiatric-drugs-and-withdrawal/

 

http://willhall.net/comingoffmeds/

 

Edited by ChessieCat
CC updated links

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Altostrata

The Harm Reduction Guide to Coming of Psychiatric Drugs PDF download links

 

Available in various languages:

 

English:  http://www.willhall.net/files/ComingOffPsychDrugsHarmReductGuide2Edonline.pdf

 

En Espanol:  Discontinuación del Uso de Drogas Psiquiátricas: Una Guía Basada en la Reducción del Daño
http://willhall.net/files/GuiaReducciondelDanoDiscontinuaciondeDrogasPsiquiatricas2EdParaImprimir.pdf

German:  Harm Reduction-Leitfaden zum risikoarmen Absetzen von Psychopharmaka
http://www.willhall.net/files/HarmReductionLeitfadenzumrisikoarmenAbsetzenvonPsychopharmaka2EdZinePrint.pdf

 

Greek:  http://www.willhall.net/files/ComingOffPsychDrugsHarmReductGuide-Greek.pdf

 

Bosnian:  http://www.willhall.net/files/ComingOffPsychDrugsHarmReductGuide-Bosnian.pdf

 

Croatian:  http://www.willhall.net/files/ComingOffPsychDrugsHarmReductGuide-Croatian-vodic-za-skidanje-sa-psihofarmaka-printing.pdf

 

Japanese:  http://www.willhall.net/files/ComingOffPsychDrugsHarmReductGuide-Japanese-ZinePrint.pdf

 

Italian:  http://www.willhall.net/files/ComingOffPsychDrugsHarmReductGuide-Italian-Printer.pdf

 

French:  http://www.willhall.net/files/ComingOffPsychDrugsHarmReductGuide-French-ZinePrint.pdf

 

Norwegian:  http://www.willhall.net/files/ComingOffPsychDrugsHarmReductGuide-Norwegian-Skadereduserende_veileder_psykofarmaka2014.pdf

 

Czech:  http://www.willhall.net/files/ComingOffPsychDrugsHarmReductGuide-Czech.pdf

 


 

Admin note: Download the latest version of the guide in English and other languages here:

 

http://theicarusproject.net/resources/publications/harm-reduction-guide-to-coming-off-psychiatric-drugs-and-withdrawal/

 

Edited by ChessieCat
CC added individual links to languages

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Rhiannon

Will Hall's doing an update of the Harm Reduction Guide now--well, he may already be done with it now, not sure. I met him in March and he was working on it then. I suggested he put in something about slower tapers because 10% every two weeks was too fast for a lot of people...looks like there's something there to that effect already.

 

I love living near Portland--there's a Rethinking Psychiatry activist group getting going there, and Will's there, and Robert Whitaker's going to be there in May. Apparently Oregon is kind of forward thinking in this regard, although the docs where I work don't seem to have heard...

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Altostrata

Thanks for that great info, Rhi. Please keep us posted about developments.

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Neuroplastic

I suggested he put in something about slower tapers because 10% every two weeks was too fast for a lot of people...looks like there's something there to that effect already.

Oh, yes, so true a case.

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summer

As a general rule, the Harm Reduction Guide recommends a 10% reduction of the original dosage every 2 weeks.

 

 

Personally, I would not reduce my dosage every two weeks. I seem to start feeling symptoms after about two weeks, and then it takes another two weeks or so to stabilize. At least six weeks works better for me.

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Rhiannon

 

As a general rule, the Harm Reduction Guide recommends a 10% reduction of the original dosage every 2 weeks.

 

 

Personally, I would not reduce my dosage every two weeks. I seem to start feeling symptoms after about two weeks, and then it takes another two weeks or so to stabilize. At least six weeks works better for me.

 

I think I will probably get to see Will Hall in a couple of weeks at a conference in Portland and if he hasn't already finished his revision I'll be sure and mention this to him. It seems to be pretty much the thing most people would like to see changed in the new version. Almost everyone agrees every two weeks is too soon if you're making 10% cuts.

 

http://www.realwealthpdx.org/2011/04/13/rethinking-psychiatry-two-day-symposium-2/

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Healing

Isn't that interesting that it's really becoming the consensus.

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Altostrata

Robert Whitaker will be there! Rhi, please tell him hello from SurvivingAntidepressants.org. He knows who we are.

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Healing

You sure you don't want to go, Sur? ;)

 

Rhi, would you please write up any interesting highlights from the symposium for us?

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Razzle

I had the good fortune to speak with Will Hall and Robert Whitaker a couple of times. Robert's work is on par with Peter Breggin in alerting the masses to the perils of psychiatric drugs.

 

I am also in the Portland area and we have a wonderful Psychiatrist, Dr. Philip Shapiro who wrote the book: Healing Power. He is anti-drug and runs wonderful healing groups in the community. The book has wonderful insights and is very spiritual (not religious) a unique perspective for a psyche doctor.

 

We used to have one of the best detox psychiatrists in the country. Dr. Schenkel, he worked for the state getting people out of intuition's because the the effects of the drugs they were on. Unfortunately budget cuts compelled him to move.

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strawberry17

Yes to the slow tapering, 10% every two weeks :blink: I'm more like 5% every 5 weeks!

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Altostrata

Has this been updated, does anyone know?

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Rhiannon

Looks like not, to me.

 

Sorry I dropped this thread--the thing in Portland coincided with my moving and it was a very stressful time for me so I sort of dropped out for a while. The conference was interesting. I only went for the Saturday part. My favorite speaker was a man who had spent some time with the folks in Finland who are doing the approach to psychosis intervention mentioned in Whitaker's book. I also finally got to meet David Oaks, and of course saw Will Hall again, although we didn't speak for long.

 

My impression is that Bob Whitaker has gotten pretty crazy busy as his book has been getting so much attention. I've dropped out of the loop a bit because I was overreaching myself and needed to cut back the stress level. Alto, what have you heard from Bob lately?

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Altostrata

Bob is doing a lot of speaking, he was in Australia recently.

 

He's transitioned from flogging his book to being a true spokesperson for psychiatric reform.

 

I know he's working on a new article for mass publication. Should be interesting to see that.

 

So, yeah, he's busy!

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Rhiannon

Bob is doing a lot of speaking, he was in Australia recently.

 

He's transitioned from flogging his book to being a true spokesperson for psychiatric reform.

 

I know he's working on a new article for mass publication. Should be interesting to see that.

 

So, yeah, he's busy!

 

Bob seems to me to be a really sweet, compassionate man.

 

And seems like he's become really dedicated to the cause of psychiatric reform. Understandably, given the people he's met and the suffering he's seen. I just wish I had the ability to be as reasonable about it in conversation as he is.

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Altostrata

Well, he doesn't suffer from iatrogenic damage himself!

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Altostrata

Topics merged and first post updated to refer to second edition. Thanks, Rhi!

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GiaK

Original post http://wp.me/p5nnb-7dS

 

I transferred links for downloading the guide, but for the rest of the informational links you need to visit the original post http://wp.me/p5nnb-7dS

 

The Harm Reduction Guide to Coming Off Psychiatric Drugs, written by Will Hall and published by The Icarus Project and Freedom Center five years ago, is now available in a revised edition!

 

This Guide can be downloaded for free on this page:

 

Harm Reduction Guide to Coming Off Psychiatric Drugs

 

and the file can be accessed directly here:

 

Harm Reduction Guide to Coming Off Psychiatric Drugs (PDF)

 

The new second edition has expanded Resources, scores of new collaborators and Advisors, new topics, more detail on the reducing and coming off process, and additional ideas for harm reduction and staying on medications. The Guide is Creative Commons copyright BY-NC-ND, meaning you have advance permission to copy, print, link, publish and share as much as you want (a special printer ready version is here, with instructions here).

 

Thousands of people worldwide have used this Guide to help themselves and people they know become more empowered around medications, including coming off. Hundreds of professionals and mental health agency staff have been downloading the free guide, to fill gaps in their own knowledge and give to their clients. Now the Guide in its second edition is even better, incorporating reader feedback and new ideas.

 

Since being published, the Guide has been translated into Spanish, Greek, and German, was featured in the Journal of Psychiatric and Mental Health Nursing, and has been used as workshop and training curriculum. 5 years ago what seemed to many as an unspeakable topic too radical for print has proven to be wildly successful. It’s helping people around the world, in the words of the introduction, to “trust themselves more and take better care of one another.” (Read about the making of the Guide here.)

 

What are some of the differences with the new Second Edition:

● Expanded Resources, including vital tools such as Robert Whitaker’s Anatomy of an Epidemic and Monica Cassani’s website Beyond Meds: Alternatives to Psychiatry

● More than twice as many Collaborators and Health Care Advisors

● Additional art and graphics

● Revised science discussion, to reflect new popular awareness of neuroplasticity, neurogenesis, and epigentics

● More comprehensive section on staying on meds and harm reduction, including a list of common tests

● Additional nutrition and holistic health advice

● New conclusion on looking to the future and redefining “normal”

● A section on “do no harm” that addresses prescriber responsibility

● New consideraton of the risks of using holistic healers

● Lots of little tweaks in accuracy and comprehensiveness (such as that some medications can’t be cut with a pill cutter, and that liquid potencies can vary by brand)

● Deeper appreciation for the placebo effect and medication response as a social construction

● New section with ideas on what to do if someone you know is overmedicated.

The second edition revision was written by primary Guide author Will Hall, but was a vast collaboration over several years gathering input and engaging in dialogue. The Thank You’s list has grown to more than 50 people: Ben Abelow, George Badillo, Amy Bookbinder, Dave Burns, Kent Bye, Mick Bysshe, Monica Cassani, Oryx Cohen, Colin, Mary Kate Connor, Laura Delano, Jacqui Dillon, Dionysia Dionysius, Marc Dinacola, Dianne Dragon, dreamer, Sascha DuBrul, Empties, Steve Fenwick, Marian B.G., Vikki Gilbert, Richard Gilluly, Rhiannon Griffith, Chaya Grossberg, Molly Hardison, Gail Hornstein, Lee Hurter, Jenna, Jonah, Julie, Marianna Kefallinou, Ed Knight, Inez Kochius, Peter Lehman, Paul Levy, Krista MacKinnon, Jacks Ashley McNamara, Tsuyoshi Matsuo, Pheepho, Suzanne Richardson, Olga Runciman, Alex Samets, Sarah Seegal, Seven, Janice Sorensen, Lauren Spiro, Bonfire Madigan Shive, Stacco, Jessica Max Stein, Terramuggus, Amy Upham, Agustina Vidal, Dorea Vierling-Claassen, and Robert Whitaker.

 

After the Guide was released many medication prescribers and clinicians expressed their strong support for its balanced and empowering message. The Health Care Professional Advisors list is now up to 53 doctors, nurses, acupuncturists, counselors, and even a shaman or two: Ed Altwies, David Anick, Ron Bassman, Alexander Bingham, Patrick Bracken, Christopher Camilleri, Michael Cornwall, David Cohen, Celine Cyr, Patricia Deegan, Jacqui Dillon, Kelley Eden, Neil Falk, Daniel Fisher, Mark Foster, Chris Gordon, Jen Gouvea, Mark Green, Nazlim Hagmann, Will Hall, Lee Hurter, Gianna Kali, Peter Lehmann, Bruce Levine, Bradley Lewis, Krista Mackinnon, Daniel Mackler, Rufus May, Elissa Mendenhall, Renee Mendez, Dawn Menken, Arnold Mindell, Joanna Moncrieff, Pierre Morin, Matthew Morrissey, Sharna Olfman, Catherine Penney, Maxine Radcliffe, Myriam Rahman, Lloyd Ross, Judith Schreiber, Michael Smith, Susan Smith,Claudia Sperber, Linda Star Wolf, Peter Stastny, Ted Sundlin, Philip Thomas, Krista Tricarico, Toby Watson, Charles Whitfield, and Damon Williams.

Seth Kadish and Cheryl Weigel joined as designers, and the facillitator crew at Portland Hearing Voices played an important role sustaining the work.

Thanks to everyone involved with making this possible — please download the new version here and spread it around!

 

I transferred links for downloading the guide, but for the rest of the informational links you need to visit the original post http://wp.me/p5nnb-7dS

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Barbarannamated

THANK YOU to all who have contributed to this - Gia, Rhi, Alto to name a few...

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strawberry17

I think this is worth bumping to the top. I think the Icarus Project is really good and definately worth a read for anyone contemplating tapering off. However I haven't found time to look at the new second edition yet.

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Rhiannon

Bump, because good.

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felin

Hi Admin,

 

Not sure if you were aware, so thought I'd mention that a few of the links that you have in the original post on this thread are saying "the page you have requested doesn't exist"

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felin

:)

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Altostrata

If you use site search, you will see existing discussions of this.

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